I know what you’re thinking…your doctor has probably been wrong more than ten times. I agree, but there have been times when the standard of care across the country has changed on a dime, and physicians went from routinely prescribing a medication to learning it may not be helpful at all.
Here are ten notable “whoops” times.
- Hormone replacement therapy (HRT). For years, physicians were initiating HRT in postmenopausal women praising its protection against stroke and heart disease. Well, the data showed otherwise. Hormone replacement therapy is the best treatment for relief of hot flashes and night sweats, vaginal dryness, and may protect against bone loss early in menopause. The problem? Combined hormone therapy is also linked to a small increased risk of heart attack. Some research suggests that women who start combined therapy within 10 years of menopause and who are younger than 60 years, may get some protection, but HRT should not be used solely to protect against heart disease.
- Digoxin (Digitek or Lanoxin). The warnings here keep getting stronger, and this year we learned that in patients with atrial fibrillation without heart failure, Digoxin was significantly associated with sudden cardiac death. The association between Digoxin use and poor clinical outcomes highlights the need to examine its use, particularly when prescribed to control heart rate in patients with atrial fibrillation. There are newer safer options.
- Bisphosphonates. This class includes medications like alendronate (Fosamax) and ibandronate (Boniva), which are indicated for the treatment of osteoporosis. When they were first approved, physicians prescribed these medications to women who had early signs of bone loss or bone thinning to prevent osteoporosis. The problem? Bisphosphonates inhibit bone remodeling and reduce the bone repair process which can lead to fractures. While they are still used for the treatment of osteoporosis and help prevent hip and spine fractures, they are not indicated for those with just mild thinning or mild bone loss.
- NSAIDS. Naproxen, Motrin, and Advil were believed to be relatively safe and effective even when used long term. Now we know that anyone who is at risk for or who has cardiovascular disease (coronary artery disease) may have a further increase in the risk of heart attacks when taking an NSAID. Let me be clear though, short-term intermittent use is fine.
- Proton pump inhibitors (PPI). The long-term use of proton pump inhibitors is also gathering more worrisome data. Turns out, you should try not to take proton pump inhibitors long-term. Medications in this class include omeprazole, esomeprazole, and pantoprazole. While they work well for reflux, esophagitis, gastritis and ulcer disease, it now appears that PPI use can lead to a higher risk of stomach cancer. Additionally, long-term use can also lead to vitamin B12 deficiency, increased risk of c-diff diarrhea, and some bone loss.
- Steroids. Physicians used to prescribe oral steroids for everything from poison oak, itchy rashes, allergies and ear congestion. A Medrol dose pack or prednisone for less severe illnesses is not recommended. Studies suggest that even short courses of oral steroids are associated with adverse effects that should be considered before prescribing
- Niacin, Tricor and gemfibrozil. Up until last year, physicians were prescribing these in combination with the cholesterol-lowering meds “statins.” However this combination showed little benefit, and the two are not recommended by the FDA for co-administration. This move also affected Niacin, fenofibric acid, Advicor, and Simcor. The FDA determined that the benefits of these medications along with statins no longer outweigh the risks.
- Avastin (bevacizumab). This was another medication that had its FDA approval yanked. Used for metastatic breast cancer, FDA approval was revoked when it was not shown to provide a benefit in terms of delay in the growth of tumors. Nor is there evidence that use of Avastin helped women with breast cancer live longer or improve their quality of life. Depressing.
- Epogen (epoetin alpha). This injection is given to stimulate red cells. Up until 2011, we were using it for the treatment of anemia (low red blood cell count) in people with kidney disease. That was until a study showed that the use of Epogen in these patients was associated with a 30% increased risk of acute stroke. Ugh.
- Diet meds. There has not been a great track record for weight loss medications. Fen Phen many of you remember was pulled from the market in 1997 after contributing to pulmonary hypertension and heart valve disease. Much later came Meridia (Sibutramine) for weight loss which was pulled in 2010 due to increased risk of stroke and heart disease. So, there’s that.
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